Citation Nr: 20046523 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 16-19 012A DATE: July 13, 2020 ORDER Service connection for hypertension is denied. A 20 percent rating, but no higher, for a duodenal ulcer is granted. FINDINGS OF FACT 1. The Veteran’s hypertension did not manifest within one year of separation from service, and it is not proximately due to or aggravated by his service-connected duodenal ulcer. 2. Resolving any reasonable doubt in the Veteran’s favor, his duodenal ulcer is best characterized by continuous moderate symptoms. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.310. 2. The criteria for a 20 percent rating, but no higher, for a duodenal ulcer have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.114, Diagnostic Code 7305. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1971 to December 1972. This case returns to the Board of Veterans’ Appeals (Board) following a remand to the agency of original jurisdiction (AOJ) in November 2018. The AOJ substantially complied with the Board’s remand instructions and the claim is ready for further review. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Service connection for hypertension The Veteran contends his hypertension is secondary to his service-connected duodenal ulcer. Alternatively, he has suggested he was diagnosed with hypertension during service. After careful review, the Board finds that service connection is not warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection generally requires evidence satisfying three criteria: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Secondary service connection may be granted when a disability is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 447-48 (1995). Service connection may also be established for certain chronic diseases, such as hypertension, which manifest to a compensable degree within a one-year presumptive period following separation from service. 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease is not shown to be chronic during service or within the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1338. For VA purposes, a diagnosis of hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. “Hypertension” means that diastolic blood pressure is predominantly 90mm. or greater, and “isolated systolic hypertension” means that systolic blood pressure is predominantly 160mm. or greater with diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Service treatment records show no diagnoses, treatment, or complaints of hypertension prior to separation. Blood pressure readings taken during service were consistently within normal limits for VA purposes. Similarly, blood pressure readings in February 1974, September 1981, January and March 1982, January and February 1983, February 1986, and January 1993 were all normal. There is no mention of hypertension in the Veteran’s medical records until January 2002, when the Veteran reported a history of arterial hypertension. VA providers diagnosed him with essential hypertension one month later. This 30-year absence of documented complaints for hypertension after separation is one factor that weighs against service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). During a VA examination in January 2020, the Veteran reported “he was told he was hypertensive” in 1971. However, he could not recall how long he had been taking medication. After interviewing the Veteran and reviewing his claims file, the examiner determined his hypertension is less likely than not proximately due to his service-connected disability, because duodenal ulcers are not a known cause of hypertension. The examiner also determined it was less likely than not that the ulcer had aggravated his hypertension beyond its natural progression. In reaching this conclusion, the examiner noted the Veteran’s medical records demonstrated variable control of blood pressure over the years, ranging from good to poor control, and these variations did not correspond to any complaints of ulcer symptoms. The Board finds the examiner’s uncontradicted opinion to be probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran has not submitted or identified any other evidence which contradicts the VA examiner’s opinion, or which otherwise supports service connection on any basis. Although he told the examiner he was hypertensive during service, there is no other evidence of a diagnosis or treatment prior to 2002. The Veteran, as a layperson, is generally competent to report his medical history. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, in this case, the Board places greater probative weight on the contemporaneous medical evidence, which shows consistently normal blood pressures for VA purposes during service and for several years afterward. In sum, the preponderance of evidence is against service connection for hypertension. As such, the benefit-of-the-doubt rule is not applicable in this instance. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The appeal must be denied. 2. Increased rating for a duodenal ulcer The Veteran seeks a rating higher than 10 percent for his duodenal ulcer. The Board finds that a 20 percent rating, but no higher, is warranted. Disability evaluations are determined by the application of VA’s Schedule of Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, a higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Under Diagnostic Code 7305, a 10 percent rating is assigned for a mild duodenal ulcer, with recurring symptoms once or twice yearly. A 20 percent rating is assigned for a moderate duodenal ulcer, with recurrent episodes of severe symptoms two or three times a year averaging 10 days in duration, or with continuous moderate manifestations. A 40 percent rating is warranted for a moderately severe duodenal ulcer, which is less than severe but with impairment of health manifested by anemia and weight loss, or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. A maximum 60 percent rating is assigned for a severe duodenal ulcer, with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, and manifestations of anemia and weight loss productive of definite impairment of health. 38 C.F.R. § 4.114. During a June 2015 VA examination, the Veteran reported periodic abdominal pain relieved by standard ulcer therapy, periodic nausea occurring four or more times a year, and no incapacitating episodes. The examiner characterized his recurring symptoms as “not severe.” The examiner noted no functional impact from these symptoms, and no other pertinent physical findings, complications, conditions, signs or symptoms. In lay statements from July 2015 and May 2016, the Veteran asserted he experienced constant severe pain, periodic vomiting, and weight loss related to his ulcer. Based on these statements, the Board remanded for a new examination. At his January 2020 examination, the Veteran described episodes of “sharp cutting pain like a knife that starts from his throat and descends to the stomach, followed by vomiting, frequently of blood.” These episodes reportedly occurred about twice a month. Like the first examiner, this examiner characterized his recurring symptoms as “not severe,” and noted no functional impact or other pertinent physical findings. VA treatment records reflect the Veteran had a history of anemia. However, his anemia had resolved by the time he filed for an increased rating in April 2015, and subsequent reports show no recurrence. In May 2016, he complained of abdominal cramping and discomfort, nausea, vomiting, and occasional episodes of diarrhea. However, he consistently denied gastrointestinal symptoms, including abdominal pain, hematemesis and melena, during primary care visits throughout the period on appeal. The Veteran has not submitted or identified any other evidence in support of an increased rating. Based on the foregoing, the Board finds that the record reasonably supports a 20 percent rating. By the Veteran’s own competent, credible account, he experiences some—but not all—of the subjective symptoms associated with the “severe” rating under the diagnostic code. There is no indication he has ever experienced recurrent incapacitating episodes. Nor is there any indication that he had anemia during the period on appeal. Resolving any reasonable doubt in his favor, the Veteran’s disability is best characterized by continuous moderate symptoms. Gilbert, 1 Vet. App. at 53. Accordingly, a 20 percent rating, but no higher, is granted. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.Z. Wall, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.